Department for Children and Families IS-4315
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Email: Gender
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TANF $ per month Medical SSI
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Child Care Plan in Place SSDI $ per month
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CN Email
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https://content.dcf.ks.gov/EES/KEESM/Forms/IS-4315EmploymentServicesReferraltoVocationalRehabilitation08-21.docxView duplicates
Your Current Name: Your Telephone: Your Street Address: Your City/State/Zip: Your
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your identifying information (name, address, email address and/or telephone numbers), do not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0330.doc
Pre-ETS Email and Phone Number
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Student’s email
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Parent/Guardian’s email
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Student’s accommodations/auxiliary aid needs or food allergies if applicable
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If you do not accept the referral the
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https://www.dcf.ks.gov/services/RS/Documents/service_descriptions/EmpowerME_referral2.docx
☐ Attach and email all forms to the grantee/provider, regional Family First mailbox and your
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Use the email subject line: FF_county abbreviation_Lastname_Firstname_4310_Closure
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS4310.docx
(if different from above): Father’s name
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Name: Address: Phone Number: E-Mail Address: Section VI: Additional Information
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(Email to DCF 30 days prior to the end of aftercare
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5M.doc
Provider: Assigned Provider Staff: Phone: Email: Date Aftercare started: Agreement in
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Frequency and method of contacts between case manager and child/family
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3070.doc
I hereby give my permission to the Kansas Department for Children and Families to release
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your identifying information (name, address, email address and/or telephone numbers), do not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0350.doc
Referral from Pre-ETS to Kansas Workforce Centers
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Pre-ETS Email and Phone Number
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Method Key Staffing is paying the student
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Student’s email
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Parent/Guardian’s email
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Put a checkmark in the box
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https://www.dcf.ks.gov/services/RS/Documents/service_descriptions/WBLreferral_workforce4.docxView duplicates
If your child is attending school virtually either full or part-time for the 2020-2021 school year
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EES Email
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Save and attach to an email to the office serving the county where you live
https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/Instructions for Submitting Child 2020 School Schedule Form.docxView duplicates
Send a scan of the form to the EBT Unit as an attachment to an e-mail to DCF.EBTMAIL@ks.gov
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portions of the form are completed, email the completed form to the Administrative Office
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3142EBT_Ben_Repay05-22.docView duplicates